International Media Watch of news headlines and current affairs reports about Romania

Tuesday, February 5, 2013

The Economist: A shortage of cancer drugs

Romanian politicsA shortage of cancer drugs

Jan 28th 2013, by L.C. | BUCHAREST

THOUSANDS of cancer patients in Romania struggle everyday to find the drugs their life depends on. The country has been facing a severe cancer-drug shortage over the last two years as more than 20 types of medicine, especially the cheap ones, are very difficult or impossible to obtain.

Last week the government revealed its budget for 2013, which didn’t include any particular provision to solve the cancer-drug shortage. Faced with strong public pressure, Victor Ponta, the prime minister, said two days after the budget announcement that the treasury will lend €800,000 ($1,078,000) to Unifarm, the state company in charge of acquiring and distributing drugs to medical institutions around the country. This fund would help Unifarm purchase from the external market the drugs that are currently missing from the hospitals as foreign companies ask for an advance payment, which usually must be made in less than 30 days. The distribution was blocked because in many cases the national health insurance house (coordinated by the ministry of health) delayed the payments for more than 200 days.

Offering money to Unifarm will not solve the problem. Thanks to bureaucracy and diverging regulations the health-care system in Romania is chaotic. “The problem is not the money; most of the cancer drugs missing are very cheap. The problem is those who are in charge of providing these drugs,” says an oncologist in Bucharest who asked to remain anonymous. Unifarm is not the only agency purchasing the drugs. There are plenty of other private distributors that win the auctions because they offer very small prices. After a few months, they are incapable of providing the drugs any longer so they block the distribution. “Who are the people behind these small companies? Some appear to be registered in an apartment. Are they even legal? If they are incapable of providing cheap medication on the market, why isn’t anyone punishing them?” asks the oncologist. At the Oncology Institute in Bucharest some of the cancer drugs, such as Bleomycin or Cisplatin, are missing because the company that had to provide them didn’t respect the contract.

While doctors and hospitals managers are overwhelmed with this situation, cancer patients are struggling to purchase the drugs on their own though they are entitled to free medication according to the law. Some Romanians who are frequently traveling to Western Europe buy these drugs and send them home to their sick friends or relatives. There is even a websitecalled “Missing Drugs” where patients can fill in a form with the drugs they need and volunteers in Europe try to find the medicines and send it to them.

“I have been desperately looking for Bleomycin in every single deposit and pharmacy in Bucharest, but I couldn’t find it”, says Marius, who was diagnosed with testicular cancer last summer. “If you go into a hospital and ask for a cytostatic, they say there isn’t any left but if you give a bribe to the right person, the cytostatic appears out of the blue. This is why some people die and some don’t in Romania. It’s all about the money.”

“Romania is facing a major cytostatic crisis”, says Cezar Irimia, who runs the Romanian federation of cancer patients association. “What is worse is that some of the patients are so desperate that they buy the drugs from the corner of the street or order them from some dubious websites. For them, death comes via the internet! ”

The shortage was aggravated by parallel exports estimated to be as high as 20% for some medicines. Several drugs are registered in Romania (which has the lowest prices for drugs in the EU) and re-sold to Western countries such as Germany, where prices are significantly higher.

Part of the problem can only be solved in Brussels. Eugen Nicolăescu, Romania’s health minister, told our correspondent “there is a difference between the situation in which the state ensures therapies and treatments for cancer patients and what is going on at a European level, which is related to the purchase of some drugs that are not attractive anymore for producers and distributors.”

The financial crisis has put pharmaceutical companies under moral pressure to maintain drug production in order to avoid a health crisis even if it is not lucrative. Even so, some drug companies abandoned production of widely used cheap chemotherapy drugs because it is not profitable enough. In a letter addressed last year to the European heads of states, Andrew Witty, the chief of Europe’s drug industry, said a more vigorous innovation policy is needed.

The situation got worse in Romania compared to other EU countries because the country’s health-care system is underfunded, highly corrupt and its drug regulation is inadequate. The state never established a back-up plan for a drug crisis in order to avoid depending entirely on pharmaceutical companies.